Application Request Form for Engineers and OEM Customers

Application Request Form

To receive applications engineering assistance, please fill out the form below and either
1. Click "SUBMIT" at bottom of form to transmit over e-mail, or
2. Print out and FAX to 585.272.5427.

Please provide the following contact information; items with asterisks "*" are required for us to contact you.

First name
*Last name
Title
*Organization
*Street Address
Address (cont'd)
*City
*State/Province
*Zip/Post Code
County if not USA
*Work phone
*FAX
*e-mail
Your time zone
*IMPORTANT: Best time to call you
Please note: Our operating hours are 9 am-5 pm EST

Fiber Coupled lasers | Diode Laser Modules & Accessories
Distance Measuring Interferometer| Telescope laser Collimator

FIBER COUPLED LASERS
Nominal wavelength in nm
Tolerance in nominal wavelength (typically ±10 nm)
*Wavelength variation w/ temp.(typically 0.25 nm/°C)
Single or multiple longitudinal mode operation
Coherence length requirements if applicable
Output power in mW (at fiber tip)
CW or modulated output
Specify digital or analog input and nominal modulation frequency
Single or multimode fiber
Fiber connector type (FC/PC, PC/APC, SMA, ST, or other)
Other requirements
Quantity needed
*Use of a thermoelectric cooler may be recommended
Please describe your application: YES! Please mail me your catalog for Fiber Coupled Lasers

DIODE LASER MODULES AND ACCESSORIES
Nominal wavelength in nm
Tolerance in nominal wavelength (typically ±10 nm)
*Wavelength variation w/ temp.(typically 0.25 nm/°C)
Single or multiple longitudinal mode operation
Coherence length requirements if applicable
Output power in mW
CW or modulated output
Specify digital or analog input and nominal modulation frequency
For collimated laser, beam diameter mm & divergence half angle mrad
For focused laser, spot diameter microns & distance from laser mm
Circularized Beam
Mounts, collimators, lens adapters required
Thermoelectric Cooler
Other requirements
Quantity needed
*Use of a thermoelectric cooler may be recommended
Please describe your application: YES! Please mail me your Diode Laser Modules & Accessories Catalog

TELESCOPE LASER COLLIMATOR (For Newtonians only)
Make of your telescope
Quantity needed
Please describe your application: YES! Please mail me your Telescope Laser Collimator Catalog


For more info call tel 800.LASER.03 (toll free) tel 585.272.5420 (locally) fax 585.272.5427	LaserMax, Inc. 3495 Winton Place, Bldg. B Rochester, NY 14623